FIONA ANDERSON
Dependent on policy B04M000769
Claims
3
Attributed to this person
Charged
1,219.00
Total submitted
Denied
279.00
2 denied claims
Patient responsibility
214.50
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | FIONA ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000769 |
| Date of birth | 28 Mar 2008 |
| Plan | BRONZE EPO |
| Covered from | 16 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 214.50 |
| Total | 214.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003352 | 8 Nov 2024 | 330.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0003354 | 24 May 2024 | 279.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 279.00 |
| CLM0003353 | 9 Apr 2024 | 610.00 | MERIDIAN HEALTH PLAN | Not denied | — |